Xolair for allergic rhinitis may become a future treatment option for patients. Currently Xolair which is an anti-IgE antibody is indicated for moderate to severe persistent asthma and chronic idiopathic urticaria. But the mechanism of action lends itself to treating allergic rhinitis.
Allergic rhinitis is one of the most common and increasing diseases worldwide, affecting more than 500 million people. Major symptoms are sneezing, watery nose, nasal congestion, nasal itching and itchy/watery eyes.
Oral antihistamines and nasal steroid sprays are the primary treatment options for allergic rhinitis. Singulair and nasal decongestants are also used for patients with severe nasal congestion.
New treatment options are needed for patients who fail the conventional medications. Xolair prevents the IgE-mediated allergic cascade, which would make it effective for allergic rhinitis. Previous studies have shown it to be effective in allergic rhinitis for ragweed, birch pollen and dust mites.
A recent study published in The Journal of Allergy and Clinical Immunology: In Practice looked at the efficacy of add-on Xolair for allergic rhinitis for those inadequately controlled severe allergic rhinitis despite use of nasal steroids and oral antihistamines in those allergic to Cedar pollen in Japan.
- The Xolair group had significantly improved their ocular and nasal symptoms compared to the placebo group who were taking nasal steroids and antihistamines.
- The Xolair group also improved their Quality of Life measures compared to the placebo group.
- The Xolair group tolerated the mediation well without significant adverse effects.
One major factor not discussed in the study was the cost of Xolair. Nasal steroids and oral antihistamines are both available in generic forms and are available at low costs the patient. Xolair for allergic rhinitis would raise the cost of treating patients significantly more. Depending on the dose of Xolair, it can usually average several thousands of dollars per month. For chronic idiopathic urticaria and severe persistent asthma, Xolair may actually be cost effective as it would prevent ER visits and hospitalizations for those not treated. But further studies would need to be done on Xolair for allergic rhintis as most of these patients are never seen in the ER or hospitalized, although they may miss work and/or school.
Nevertheless, Xolair for allergic rhinitis may be a future treatment option for patients with severe allergic rhinitis not controlled by medications and if the cost of Xolair goes down in the future. Xolair can possibly used for any type of trigger causing allergic rhinitis such as trees, grasses, weeds, dust mites, cat, dog or mold allergies.